UCLA Medical Center gets failing grade on patient safety

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks.

In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths.

Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Officials at UCLA disputed the failing grade and they said one patient death in 2010 unfairly lowered its grade from a C to an F under Leapfrog's methodology.

"UCLA is not an F hospital in quality and safety," said Tom Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center. "It is not a fair scoring system and it does a disservice to the public."

This debate over UCLA's score comes amid a proliferation of healthcare ratings by outside organizations trying to provide more information to consumers and employers. These scores are also taking on greater importance as some insurers and employers use them as one factor in determining whether a hospital or doctor should be included in a provider network.

Given those stakes, the California Hospital Assn. has called on Leapfrog and other rating organizations to offer more details on how their scores are tabulated and to focus on reliable measures that can assess patient care. Some highly regarded hospitals across the country, such as UCLA, fare well in one ranking and then poorly in the next.

Leapfrog gave an F to one other area hospital, Western Medical Center Anaheim. The hospital said it disagreed with Leapfrog's rating methods and added that it "continuously adds new systems to enhance our patient care."

Cedars-Sinai Medical Center received an A in Leapfrog's June report, but its grade dropped to a C on this latest review, which included more recent data from last year. Thirty Kaiser Permanente hospitals received an A and one got a B from Leapfrog.

Experts urge consumers to use these score cards as one tool in evaluating a hospital and to discuss any specific concerns with their doctor and other medical providers.

Leapfrog estimates that 180,000 Americans die annually from hospital accidents, errors and infections, and it says hospitals need to do more to protect patients from harm. Its hospital safety score is derived from 26 measures of publicly reported data.

Rosenthal said UCLA scores well on healthcare quality and patient outcomes on numerous measures tracked by the federal government and other rating organizations, suggesting that Leapfrog's methods are potentially flawed.

He said a liver transplant patient died during surgery in 2010 from an air embolism, one of several preventable medical errors that Leapfrog and other groups regularly track. Rosenthal said the patient's death was a regrettable mistake, but that error hasn't occurred since then.

Leah Binder, Leapfrog's president and chief executive, said her group's scoring methods are statistically valid and devised by a panel of leading experts in patient safety. She said UCLA scored poorly in several areas of patient care, such as foreign objects left in a patient during surgery and pressure ulcers.

"It isn't just one incident that gave them a score so far below the national average," Binder said. "We see it all the time that a hospital might have a stellar reputation, but behind the scenes they aren't safe for many of their patients."

On pressure ulcers, Rosenthal said, UCLA looked worse than its actual performance because of over-reporting in the hospital billing data that was reviewed by Leapfrog.

Overall, Leapfrog gave an A or B to 1,468 hospitals, or 56% of the 2,618 reviewed nationwide. The group issued a C to 1,004 hospitals, or 38%. At the bottom, 146 hospitals, or 6%, were labeled D or F.

Leapfrog reviewed 246 hospitals in California. The ratings are available online at http://www.hospitalsafetyscore.org.

chad.terhune@latimes.com

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Much talk, little action on 'fiscal cliff' as Congress returns

WASHINGTON — Congress returned to a lame-duck session with no signs of quick compromise to ease the nation's budget deadlock, and the White House rolled out a strategy Monday to marshal popular support for raising taxes on the wealthiest tier of income earners.

Closed-door talks by senior aides produced no clear progress despite President Obama's private phone call over the weekend to House Speaker John A. Boehner (R-Ohio) in an effort to forge a deficit reduction deal in the five weeks before current tax rates expire, which would lead to tax increases for most Americans.

Familiar lines began to form as both sides jockeyed to avoid the so-called fiscal cliff, the combination of $500 billion in automatic federal tax increases and spending cuts that economists warn could send the nation back into recession next year.

But the battle assumed new contours as some senior Republican lawmakers distanced themselves from their party's strict anti-tax pledge and Obama took his case public. He warned that the threat of a tax hike on ordinary Americans could dampen winter holiday spending and create a crisis in consumer confidence.

"The president has called on Congress to take action and stop holding the middle class and our economy hostage over a disagreement on tax cuts for households with incomes over $250,000 per year," the White House said in a statement.

Obama got a boost from billionaire investor Warren Buffett, who said wealthier Americans, including himself, should pay more taxes. He dismissed Republican arguments that such tax increases would hamper investment.

"In recent years, my gang has been leaving the middle class in the dust," Buffett wrote in an op-ed for the New York Times. "Let's forget about the rich and ultrarich going on strike and stuffing their ample funds under their mattresses if — gasp — capital gains rates and ordinary income rates are increased."

The broad outline of a deal could be seen, although any accord appeared far from imminent.

Over the last week, three top Republican lawmakers — Sen. Lindsey Graham of South Carolina, Sen. Saxby Chambliss of Georgia and Rep. Peter T. King of New York — all indicated they were willing to raise some taxes in exchange for an agreement from Democrats to curb spending. They broke publicly with conservative stalwart Grover Norquist, the influential president of Americans for Tax Reform.

"It's fair to ask my party to put revenue on the table," Graham said on ABC's "This Week." "I will violate the pledge, long story short, for the good of the country — only if Democrats will do entitlement reforms."

A framework for a compromise had emerged after the Nov. 6 election. Boehner proposed a two-step process that would put a down payment on deficit reduction this year and set targets for undertaking a comprehensive overhaul of taxes and entitlement spending in 2013.

In the days since, however, talks have become "slow," according to one congressional aide. Republicans insist that new revenue must come from economic growth, which they believe would be produced by revamping the tax code to lower all tax brackets — an approach Democrats reject as "fairy tale" economics.

Democrats are unwilling to discuss cuts to Medicare, Medicaid or other government programs unless Republicans put upfront revenue on the table, aides said.

Frustrations over the standoff have grown, and one lawmaker, Sen. Bob Corker (R-Tenn.), proposed his own solution Monday — capping itemized deductions at $50,000 in exchange for changes to Medicare and cuts to other government programs.

Such an approach is in line with proposals being discussed, though Obama has promised the tax increases would hit incomes only above $250,000 for couples or $200,000 for singles.

No talks among the principal players are scheduled this week, even though both sides say they want to avoid brinkmanship as they push toward a Christmas deadline. All tax rates expire on Dec. 31, which would result in automatic tax increases; spending cuts are set for Jan. 2.

Aides to the president acknowledged they didn't hold high hopes after Obama spoke to Boehner over the weekend. But they didn't go so far as to echo Senate Republican leader Mitch McConnell of Kentucky, who used the word "impasse" Monday in discussing the long pursuit of a grand budget deal.

"We remain confident we can achieve an agreement," White House Press Secretary Jay Carney said. "We remain hopeful and optimistic we can reach a deal."

Staff negotiations continue, and the White House's Council of Economic Advisers said Monday the automatic tax increases would not only hurt the rest of the holiday shopping season, but they could also trim consumer spending by about $200 billion in 2013. Overall, the council warned, economic growth could drop by 1.4 percentage points.

That's no small matter, said the council's chairman, Alan Krueger, given the role retail sales play in the economy. The American economy has grown at an average annual rate of just over 2% since the recovery began in 2009.

The report is broadly consistent with forecasts by the Congressional Budget Office and leading private economists, and it comes after retailers amassed a record $59.1 billion in sales from Thanksgiving through Sunday, up from $52.4 billion a year earlier, according to estimates from the National Retail Federation.

But the White House report warned that "the hard-earned rise in consumer confidence will be at risk if the middle-class tax cuts are not soon extended with a minimum of political drama."

Publicly and behind closed doors, White House officials expressed hope that the political environment would improve over the coming week.

Obama will meet with business leaders at the White House this week in an attempt to build support for his agenda.

On Friday, the president plans to travel to Montgomery County in Pennsylvania to visit a local business that "depends on middle-class consumers during the holiday season," the White House said. The business, Rodon Group, is the sole American manufacturer for K'NEX Brands, a construction toy company whose products include Tinkertoy, K'NEX and Angry Bird building sets.

lisa.mascaro@latimes.com

christi.parsons@latimes.com

Times staff writer Don Lee contributed to this report.

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India: 2 policemen suspended, magistrate transferred for arrest of 2 women over Facebook post

NEW DELHI – An Indian official says two senior policemen have been suspended for arresting two women over a Facebook post criticizing the shutdown of Mumbai for the funeral of a powerful politician.

Maharashtra state Home Minister R.R. Patil said Tuesday the policemen were suspended indefinitely and the magistrate who registered the case against the women has been transferred to another district.

Police also arrested nine men who vandalized a medical clinic run by the uncle of one of the women, Patil said.

One of the women had posted a Facebook comment complaining that Mumbai had come to a standstill after the death of rightwing leader Bal Thackeray. Her friend “liked” the post.

Their arrest last week was seen as a misuse of Internet laws and an attempt to curb freedom of expression.

Social Media News Headlines – Yahoo! News

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Berry's ex says he was threatened before fight

LOS ANGELES (AP) — Halle Berry's ex-boyfriend claims the actress's fiance threatened to kill him during a Thanksgiving confrontation that left him with a broken rib, bruised face and under arrest.

Gabriel Aubry's claims are included in court filings that led a judge Monday to grant a restraining order against actor Olivier Martinez, who is engaged to the Oscar-winning actress.

Aubry, 37, was arrested on suspicion of misdemeanor battery after his confrontation with Martinez on Thursday, but he states in the civil court filings that he was not the aggressor and that he was threatened and attacked without provocation. Martinez told police that Aubry had attacked first, the filings state.

A representative for Martinez could not be immediately reached for comment.

Aubry's filing claims Martinez threatened him the day before the fight at an event at his daughter's school that he and the actors attended. Aubry, a model, has a 4-year-old daughter with Berry and the former couple have been engaged in a lengthy custody battle.

The proceedings have been confidential, but Aubry states a major aspect of the case was Berry's wish to move to Paris and take her daughter with her. The request was denied Nov. 9, Berry's court filings state, and Aubry shares joint custody of the young girl.

Aubry claims Martinez told him, "You cost us $3 million," while he was punched and kicked him in the driveway of Berry's home. Aubry had gone to the home to allow his daughter to spend Thanksgiving with her mother, the filings state. Aubry claims Martinez threatened to kill him if Aubry didn't move to Paris.

Berry was not in the driveway during the confrontation and neither was their daughter, the documents state.

Photos of Aubry's face with cuts and a black eye were included in his court filing.

A judge set a hearing for Dec. 17 to consider whether a three-year restraining order should be granted. Aubry has a Dec. 13 court date for the possible battery case, which has not yet been filed by prosecutors.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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The New Old Age Blog: New Efforts to Close Hospitals' Revolving Doors

In the past, the only thing a patient was sure to get after a hospital stay was a bill. But as Medicare cracks down on high readmission rates, hospitals are dispatching nurses, transportation, culturally specific diet tips, free medications and even bathroom scales to patients deemed at risk of relapsing.

Robert Wood Johnson University Hospital in New Brunswick, N.J., has nurses visit high-risk patients at their home within two days of leaving the hosital. Teresa De Peralta, a nurse practitioner who runs the program, said they frequently find that patients don’t realize a drug they were prescribed in the hospital does the same thing as one they have already been taking.

“When medications are changed, they don’t want to throw things out, they think it’s a waste,” Ms. De Peralta said. “We actually go through the cupboards and painstakingly write out in big letters what they should be taking during the day.”

Many hospital officials say their efforts to keep patients healthy after discharge have been spurred by new financial penalties Medicare started imposing in October on places with too many readmissions. Increasingly, hospitals are no longer leaving to patients the responsibility for setting up follow-up appointments or filling new prescriptions.

And hospitals are not assuming that personnel in nursing homes and other facilities know how to properly care for their patients and follow the hospital discharge instructions.

Patients taking the wrong dose or mixing medicines that react badly often end up back in the hospital. A survey of 377 elderly patients at Yale-New Haven Hospital, published this year in The Journal of General Internal Medicine, discovered that 81 percent of the patients either didn’t understand what all their prescriptions were for; were prescribed the wrong drug or the wrong dose; were taken off a drug they needed, or never picked up a new prescription.

Dr. Leora Horwitz, the study’s leader, said patients who were called a week after their discharge and were asked what changes to their medication they were supposed to make “overwhelmingly” couldn’t tell them.

A big part of reducing readmissions is making sure that patients understand early warning signs that their health is deteriorating. Sun Health Care Transitions, a foundation-supported program in Sun City, Ariz., gives scales to some patients with congestive heart failure because small weight gains indicate they are retaining water, a sign that their heart isn’t pumping adequately.

“We have them keep a log,” said Jennifer Drago, a Sun Health vice president. “We want them to be looking for a two-pound daily weight gain, or five pounds over the week.”

Patients whose weight creeps up are quickly sent back to their doctor. Debra Richards, director of case management at Banner Del E. Webb Medical Center, one of the hospitals Sun Health is assisting, said, “That program has helped us quite a bit.”

Shady Grove Adventist Hospital in Rockville, Md., has started taking patients’ cultural backgrounds into consideration when doling out advice about maintaining their health. For example, the hospital encourages Salvadoran patients to substitute olive oils for the palm oils their cuisine traditionally calls for, to roast or bake meat instead of frying it and to use sugar substitutes when making horchata, a popular Central American drink.

When Hackensack University Medical Center sent staff members to teach caregivers how to take care of their patients, one place “didn’t even know what a low-salt diet was,” even though that’s a critical part of keeping heart failure patients from retaining fluids, said Dr. Charles Riccobono, chief quality and safety officer at the New Jersey hospital.

Aurora Health Care, a Milwaukee-based health system, now places its own nurse practitioners in several nursing homes to watch over Aurora’s discharged patients. Aurora says readmission rates of those patients have decreased, in some months by as much as half.

Dr. Eric Coleman, a Denver geriatrician whose ideas on reducing readmissions have been adopted by a number of hospitals and Medicare, said that while some hospital changes are “exciting and new,” others are “relabeling old wine in new bottles.”

“Yesterday we had ‘discharge planning’ and today we have a ‘rapid response transition team,’ and content-wise they’re doing the same thing,” Dr. Coleman said. “But it’s a nice thing to report out to the board of trustees.”

Jordan Rau is a reporter for Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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FDA halts operations of organic peanut butter processor Sunland

The Food and Drug Administration has halted operations of the country's largest organic peanut butter processor, cracking down on salmonella poisoning for the first time with the new enforcement authority the agency gained in a 2011 food safety law.

FDA officials found salmonella all over Sunland Inc.'s New Mexico processing plant after 41 people in 20 states, most of them children, were sickened by peanut butter manufactured at the Sunland plant and sold at the Trader Joe's grocery chain. The FDA suspended Sunland's registration Monday, preventing the company from producing or distributing food.

The food safety law gives the FDA authority to suspend a company's registration when food manufactured or held there has a "reasonable probability" of causing serious health problems or death. Before the food safety law was enacted early last year, the FDA would have had to go to court to suspend a company's registration.

Sunland had planned to reopen its peanut processing facility Tuesday. A spokeswoman said before the FDA's announcement Monday that the company hoped to be selling peanut butter again by the end of the year. The spokeswoman didn't have an immediate comment on the suspension.

The company has the right to a hearing and must prove to the FDA that its facilities are clean enough to reopen.

Michael Taylor, the FDA's deputy commissioner for foods, said the ability to suspend a registration is a major step forward for the agency.

"Consumers can be assured that products will not leave this facility until we determine they have implemented preventive measures that are effective to produce safe products," Taylor said.

Sunland is the nation's largest organic peanut butter processor, though it also produces many non-organic products. The company recalled hundreds of organic and non-organic nuts and nut butters manufactured since 2010 after Trader Joe's Valencia Creamy Peanut Butter was linked to the salmonella illnesses in September.

Sunland sold hundreds of peanut products to many of the nation's large grocery chains other than Trader Joe's, including Whole Foods, Safeway, Target and others.

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Military's dogs of war also suffer post-traumatic stress disorder

LACKLAND AIR FORCE BASE, Texas — Not long after a Belgian Malinois named Cora went off to war, she earned a reputation for sniffing out the buried bombs that were the enemy's weapon of choice to kill or maim U.S. troops.

Cora could roam a hundred yards or more off her leash, detect an explosive and then lie down gently to signal danger. All she asked in return was a kind word or a biscuit, maybe a play session with a chew toy once the squad made it back to base.

"Cora always thought everything was a big game," said Air Force Tech. Sgt. Garry Laub, who trained Cora before she deployed. "She knew her job. She was a very squared-away dog."

PHOTOS: Military dogs

But after months in Iraq and dozens of combat patrols, Cora changed. The transformation was not the result of one traumatic moment, but possibly the accumulation of stress and uncertainty brought on by the sharp sounds, high emotion and ever-present death in a war zone.

Cora — deemed a "push-button" dog, one without much need for supervision — became reluctant to leave her handler's side. Loud noises startled her. The once amiable Cora growled frequently and picked fights with other military working dogs.

When Cora returned to the U.S. two years ago, there was not a term for the condition that had undercut her combat effectiveness and shattered her nerves. Now there is: canine post-traumatic stress disorder.

"Dogs experience combat just like humans," said Marine Staff Sgt. Thomas Gehring, a dog handler assigned to the canine training facility at Lackland Air Force Base, who works with Cora daily.

Veterinarians and senior dog handlers at Lackland have concluded that dogs, like humans, can require treatment for PTSD, including conditioning, retraining and possibly medication such as the anti-anxiety drug Xanax. Some dogs, like 5-year-old Cora, just need to be treated as honored combat veterans and allowed to lead less-stressful lives.

Walter Burghardt Jr., chief of behavioral medicine and military working-dog studies at Lackland, estimates that at least 10% of the hundreds of dogs sent to Iraq and Afghanistan to protect U.S. troops have developed canine PTSD.

Cora appears to have a mild case. Other dogs come home traumatized.

"They're essentially broken and can't work," Burghardt said.

There are no official statistics, but Burghardt estimates that half of the dogs that return with PTSD or other behavioral hitches can be retrained for "useful employment" with the military or law enforcement, such as police departments, the Border Patrol or the Homeland Security Department.

The others dogs are retired and made eligible for adoption as family pets.

The decision to officially label the dogs' condition as PTSD was made by a working group of dog trainers and other specialists at Lackland. In most cases, such labeling of animal behavior would be subjected to peer review and scrutiny in veterinary medical journals.

But Burghardt and others in the group decided that they could not wait for that kind of lengthy professional vetting — that a delay could endanger those who depend on the dogs.

Since the terrorist attacks of 2001, the military has added hundreds of canines and now has about 2,500 — Dutch and German shepherds, Belgian Malinois and Labrador retrievers — trained in bomb detection, guard duty or "controlled aggression" for patrolling.

Lackland trains dogs and dog handlers for all branches of the military. The huge base, located in San Antonio, has a $15-million veterinary hospital devoted to treating dogs working for the military or law enforcement, like a Border Patrol dog who lost a leg during a firefight between agents and a suspected drug smuggler.

"He's doing fine, much better," the handler yelled out when asked about the dog's condition.

Cora received her initial training here and then additional training with Laub at Moody Air Force Base in Georgia. Before they could deploy, however, Laub was transferred to Arkansas, and Cora shipped off to Iraq with a different handler, much to Laub's regret.

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Betfair pulls out of Greece over permits row

LONDON (Reuters) – Online gambling exchange Betfair said it would withdraw from the Greek market until there was greater clarity on gaming regulation in the country.

Betfair, which has not yet applied for a permit to operate in Greece, questioned the cost and conditions attached to permits required by gaming firms to trade in the country.

“According to legal advice received, the value of these permits is unclear and we consider the gambling legislation in the country to be inconsistent with European law,” Betfair said on Monday.

“The associated fiscal conditions attached to these permits, which may include payment of taxes on historical revenues, make the market economically unattractive.”

Earlier this month the Greek Gaming Commission said gambling firms operating in Greece without a permit would face financial penalties and criminal sanctions.

Betfair said it believes there are “significant issues with the legality of this decision” by the Greek Gaming Commission.

It added that it was disappointed the European Commission had not moved to prevent what Betfair calls “protectionist behavior.”

Earlier this month Betfair, which launched 12 years ago and operates an exchange system that allows gamblers to bet against each other rather than the bookmaker, withdrew its online sports betting exchange in Germany because of a tax levied on stakes on sports events from July 2012.

The European Commission last month said it was not proposing EU-wide legislation to regulate online gambling.

Prior to Betfair’s decision to withdraw from the market, it had been expected to generate 13 million pounds ($ 20.81 million) of revenue from the Greek market in the current financial year.

($ 1 = 0.6246 British pounds)

(Reporting by Rhys Jones; editing by James Davey)

Internet News Headlines – Yahoo! News

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Rolling Stones mark 50th year with London show

LONDON (AP) — The Rolling Stones made a triumphant return to the London stage on Sunday night in the first of five concerts to mark the 50th anniversary of their debut as an American-oriented blues band.

They showed no signs of wear and tear — except on their aging, heavily lined faces — as frontman Mick Jagger swaggered and strutted through a stellar two-and-a-half hour show. He looked remarkably trim and fit and was in top vocal form.

The Stones passed the half-century mark in style at the sometimes emotional gig that saw former bassist Bill Wyman and guitar master Mick Taylor join their old mates in front of a packed crowd at London's 02 Arena.

It was the first of five mega-shows to mark the passage of 50 years since the band first appeared in a small London pub determined to pay homage to the masters of American blues.

Jagger, in skin-tight black pants, a black shirt and a sparkly tie, took time out from singing to thank the crowd for its loyalty.

"It's amazing that we're still doing this, and it's amazing that you're still buying our records and coming to our shows," he said. "Thank you, thank you, thank you."

Lead guitarist Keith Richards, whose survival has surprised many who thought he would succumb to drugs and drink, was blunter: "We made it," he said. "I'm happy to see you. I'm happy to see anybody."

But the band's fiery music was no joke, fuelled by an incandescent guest appearance by Taylor, who played lead guitar on a stunning extended version of the ominous "Midnight Rambler," and Mary J. Blige, who shook the house in a duet with Jagger on "Gimme Shelter."

The 50th anniversary show, which will be followed by one more in London, then three in the greater New York area, lacked some of the band's customary bravado — the "world's greatest rock 'n' roll band" intro was shelved — and there were some rare nostalgic touches.

Even the famously taciturn Wyman briefly cracked a smile when trading quips with Richards and Ronnie Wood.

The concert started with a brief video tribute from luminaries like Elton John, Iggy Pop and Johnny Depp, who praised the Stones for their audacity and staying power. The Stones' show contained an extended video homage to the American trailblazers who shaped their music: Muddy Waters, John Lee Hooker, Otis Redding, Bob Dylan, Johnny Cash and others. The montage included rare footage of the young Elvis Presley.

The Stones began their professional career imitating the Americans whose music they cherished, but they quickly developed their own style, spawning hundreds — make that thousands — of imitators who have tried in vain to match their swagger and style.

The concert began with some early Stones' numbers that are rarely heard in concert, including the band's cover of the Lennon-McCartney rocker "I Wanna Be Your Man" and the Stones original "It's All Over Now."

They didn't shy away from their darker numbers, including "Paint It Black" and "Sympathy for the Devil" — Jagger started that one wearing a black, purple-lined faux fur cape that conjured up his late '60s satanic image.

He even cracked a joke about one of the band's low points, telling the audience it was in for a treat: "We're going to play the entire "Satanic Majesty's Request" album now," he said, referring to one of the band's least-loved efforts, a psychedelic travesty that has been largely, mercifully, forgotten.

He didn't make good on his threat.

He also made fun of the sky-high ticket prices, which had exposed the band to some criticism in the London press.

"How are you doing up in the cheap seats," he said, motioning to fans in the upper rows of the cavernous 02 Arena. "Except they're not cheap seats, that's the problem."

But Jagger seemed more mellow than usual, chatting a bit about the good old days and asking if there was anyone in the crowd who had seen them in 1962, when they first took to the stage.

He said 2012 had been a terrific year for Britain and that the Stones nearly missed the boat, playing no role in the celebration of the Queen's Diamond Jubilee, the London Olympics, or the new James Bond film.

"We just got in under the wire," he said. "We feel pretty good."

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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